Statins and risk of cataracts: A systematic review and meta‐analysis of observational studies

Abstract

Summary Introduction Two previous meta‐analyses evaluated the risk of cataracts associated with statins, but did not include relevant studies suggesting a cataractogenic effect. Aims The aim of this systematic review and meta‐analysis of observational studies is to evaluate such association considering the latest published evidence. Methods A literature search was conducted to identify observational, comparative studies evaluating the risk of developing cataracts in patients treated with statins. A meta‐analysis was performed to estimate odds ratios (ORs). Results were stratified according to the following studies’ subgroups: design, methodological quality, method of diagnosis of cataract, patients’ age, and median follow‐up. Meta‐regressions evaluated the influence of the following risk factors: smoking, hypertension, corticosteroids, selective serotonin reuptake inhibitors (SSRI), diabetes mellitus, and cardiovascular disease. Results Twenty‐one studies were included. Treatment with statins was associated with an increased risk of cataracts [OR: 1.11 (95% CI: 1.02‐1.21); P = 0.017; I2 = 97.5%]. This risk remained statistically significant among case‐controls, good methodological quality studies, studies with length of follow‐up ≥5 years and those which outcome was cataract surgery. Between‐studies heterogeneity was high among all risk estimates. Meta‐regressions identified an inverse relationship between the risk of cataracts and the proportion of diabetic patients in the studies. Conclusions The results point out an increased risk of cataract development with statins. However, since the magnitude of the effect is low and between‐studies heterogeneity is high, the extent in which these results have impact on the benefit/risk ratio of statins is difficult to ascertain due to the uncertainty of the findings.

Are lipid‐lowering drugs associated with a risk of cataract? A pharmacovigilance study

“…More important, the analysis performed after exclusion of lovastatin (in order to minimize a notoriety bias due to the fact that lovastatin was the first historically suspected statin and thus reduces attrition of susceptibles) found similar trends, clearly evidencing an increased risk of cataract report with all statins in general. However, the ROR values obtained in the present study were relatively low for disproportionality studies suggesting, in accordance with the recent meta‐analysis , that the magnitude of cataract risk with LLD is low.…”

“…Very recently, a systematic review and meta-analysis including twenty-one studies found an OR value = 1.11 (95% CI 1.02-1.21). The small magnitude of the risk was explained by high betweenstudies heterogeneity [7]. In the present analysis, we found that the four most frequently reported statins in VigiBase â were in descending order: atorvastatin, simvastatin, rosuvastatin and lovastatin and we described a significant ROR value for all statins in general.…”

Lens cholesterol biosynthesis inhibition: A common mechanism of cataract formation in laboratory animals by pharmaceutical products

“…Compared with older antipsychotic drugs (Shahzad et al, ), statins and quetiapine appear to have better safety margins based on biochemical studies of lenses obtained from humans treated with lovastatin and simvastatin where no changes in lens sterol content occurred at approved daily doses (Mitchell & Cenedella, ) and many years of safe human experience (Laties et al, ; Schlienger, Haefeli, Jick, & Meier, ; von Sallmann et al, ). Recent meta‐analysis of statin use shows little if any risk compared with its beneficial effects (Alves, Mendes, & Batel Marques, ; Yu et al, ). The mechanism of cataract formation, the site of inhibition along the cholesterol biosynthetic pathway, and drug lens exposure are necessary pieces of information to establish a clearer safety perspective (de Vries, Vermeer, Bloemendal, & Cohen, ; Mitchell & Cenedella, ).…”

Statins and the risk of cataract

“…Впервые о возможном влиянии статинов на риск развития катаракты описано в экспериментальном исследовании на собаках, получавших большие дозы препаратов этого класса [4]. Механизм, благодаря которому статины могут провоцировать развитие катаракты, до сих пор неизвестен, лишь в нескольких работах обсуждаются возможные причины такой взаимосвязи [5][6][7][8]. Результаты доклинических исследований статинов продемонстрировали решающую роль холестерина в целостности мембран и поддержании структуры, прозрачности хрусталика, поэтому прием этих препаратов и, как следствие, снижение холестерина, могут приводить к развитию катаракты [5,9,10].…”

“…В 2018г был выполнен систематический обзор и мета-анализ наблюдательных исследований для оценки риска развития катаракты у пациентов, принимающих статины [6]. Работы [2], в которых не обнаружено убедительных доказательств связи между приемом статинов и катарактой, не включали наблюдательные исследования, свидетельствующие о наличии такой ассоциации.…”